Health care, one more time

On the most important domestic issues of the day, our two political parties don’t merely lay out competing arguments; they inhabit alternative realities.

The chasm was apparent most recently as the House of Representatives churned relentlessly toward its vote to repeal President Obama’s health-care law. The two-day debate, carried out in a marathon series of two-minute speeches, remained civil. But it was clear that civility alone won’t lead to consensus.

To listen to Republicans, the healthcare law will destroy as many as 1.6 million jobs; to hear Democrats, it will create jobs.

Republicans say the law will bust the national budget and deepen the federal deficit; Democrats say the law will reduce the deficit by $230 billion over the next 10 years and even more after that. As usual, of course, the facts are more complicated than either side acknowledges.

Will the law kill jobs? In raising insurance costs for some businesses, it could deter some hiring. But by making health coverage portable, the law should also make the economy more efficient and so promote job creation in the long run. Will the law deepen the deficit or reduce it? That depends on whether Congress is brave enough to enforce cost controls on Medicare and Medicaid in the future, action that could mean lower payments to physicians and healthcare providers and restrictions on available treatments.

Unfortunately, as is usual in floor debates, the discussion didn’t get into the nuances of these real-world dilemmas. Instead, members on each side spent their allotted time reinforcing their parties’ incompatible worldviews.

To Republicans, the law will “fundamentally change the doctor-patient relationship,” freshman Rep. Ben Quayle, R-Ariz., son of former Vice President Dan Quayle, asserted in his maiden outing on the House floor — though given his two-minute limit, he didn’t spell out exactly how. To Democrats, the law “is a moral imperative. … We are our brothers’ keepers,” said Rep. Christopher Murphy, D-Conn.

What the House did, of course, wasn’t really legislation; it was politics. The new Republican leaders of the House know that the Senate, still in Democratic hands, isn’t going to give repeal a chance to get to the floor, much less pass. Instead, this was merely the opening round in a long re-litigation of the health-care debate that dominated the last Congress.

That’s why the Republicans relied on what they see as their strongest argument: the fear that extending health insurance to more of the uninsured will be too costly for small businesses and taxpayers. And that’s why the Democrats relied on theirs: the voter-pleasing consumer protections that the law enacted.

To listen to the Democrats, you’d think the cornerstone of the law was the clause that lets children stay on their parents’ insurance policies until they’re 26. On both sides, the goal isn’t to design a new health-care system but to create new political facts. The Democrats want a chance to resell a law they sold poorly the first time around and to create new vested interests around provisions that block insurance companies from denying coverage to customers with preexisting conditions.

The Republicans want to impede implementation of the new law (by blocking funding of its main provisions, among other means) long enough to win a majority in the Senate and perhaps even the White House in 2012 — their best hope for really repealing the law.

Public sentiment is still up for grabs.

Several Republican members of Congress called the law “wildly unpopular” this week, but they’re wrong. Some news reports have said the public is “evenly split” on the issue, but they’re wrong, too. An even 50 percent of the public told pollsters for ABC News last week that they favor repealing the bill, but that included 13 percent who want it repealed because they don’t think it goes far enough. The poll showed that partisan voters, like their members of Congress, live in two parallel worlds: Most Republicans say they think the law will destroy jobs; most Democrats think the opposite. But feelings about some parts
of the law actually cross party lines. Most people like the provisions
that protect patients from insurance companies, but they don’t like the
individual mandate that requires people to buy insurance whether they
want it or not. And most people worry about cost.

That’s
why Republican leader Eric Cantor, R-Va., one of the fiercest opponents
of the health-care law, promised that his party wouldn’t merely repeal
the Obama bill but would also produce new bills of its own to guarantee
the new rights that patients already hold dear.

When his lieutenants get to work this spring
on their own ideas for health-care reform — proposals Cantor promised
will protect patients, give more people access to insurance, lower costs
and reduce the deficit — the debate will turn interesting again. Then,
in the committees of the House, we’ll get a chance to hear reasoned
arguments on what the true costs of the new law will be and whether
insurance can be expanded without imposing that unpopular individual
mandate.

But we’ll
have to wait. Reasoned arguments on those issues weren’t on the agenda
during the recent floor show in the House of Representatives.